What we really need is health reform, not just health insurance reform.

Interesting, exciting, confusing, frustrating, and disappointing are just few of the more generous terms I can use to describe the current state of what is being called the “health reform” debate in the U.S.

I pose a few basic questions and respond based on what the likely outcome appears to be: an private insurance-based system with no “public option”.

Is it really “health reform”?

Hardly.Let’s call it “health insurance reform.” It’s about removing one major barrier for those without health insurance: money. However, providers of care – hospitals, physicians, and others- do not have to accept whatever payment system will be in place. So access may still be limited. For example, in the Ithaca area where I live only about half the physicians are currently accepting new Medicare and Medicaid patients. Will they accept new patients in the future?

Health insurance reform will not likely diminish the inequalities that exist due to factors such as race, gender, sexual preference, geography, education, and social status.

What would “health” reform look like?

There are two ways to answer this.

First, we would have to change the mechanism and culture of medical care.A “health” system that focuses on keeping people healthy instead of rewarding the treatment of the ill would prevent problems and likely save an enormous amount of money over the long run. Initial investments in changing our system will be costly, but will be worth it.

For example, we pay cardiologists in the thousand of dollars for performing 60 minute procedures in their offices or outpatient clinics. However, we pay them much much less for spending 60 minutes with their patients discussing ways to improve or maintain their health status such a nutrition, stress reduction, and physical activity. What do you think most doctors decide to do?

Second, let us consider the areas know as the social determinants of health.

We know that “health” is far more than access to medical treatment.Consider the “choices” one has for purchasing healthy food on a low fixed income, for example.What food stores are available in their neighborhood? What parks or recreation opportunities are available? Is their neighborhood safe?Therefore, “health” reform means doing something to increase and improve the choices one has where they live.

If the goal of reform is to improve health status for as many people as possible, then removing financial barriers to care is only one way. Investing in better housing, wider access to education (not just health education), healthier neighborhoods, food policies with consumer health as a priority, healthier workplaces, and acknowledgement of racial inequalities in health would mean real health reform.

Here are a few sources to check out:

Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S. (This is a clear and concise explanation of the social determinants of health.)

7 Comments

11:38 p.m. on September 30, 2009Hannah Antonson said,

France is the number one country in the world for health care. Is their "socialized" system really better than the United States? Certainly it is when it comes to access to care. But are people really HEALTHIER in France? Perhaps they are. They are FAR less obese, which makes them far less likely to develop obesity-related illnesses.
I believe that even if "health" reform were to take place in America in the ways mentioned, we would still be less healthy than other nations. In my opinion, it is primarily our culture that separates us. For example, we have made headway by banning trans fats in NYC and perhaps taxing sugary drinks. If only our economy did not depend so much on our wildly popular fast food chains. If only we could promote a realistic and healthy weight instead of the size zero female models or the buff male models, which cause many eating disorders, malnutrition issues, and self-esteem problems. But perhaps I dream too big.

9:55 p.m. on October 5, 2009Jenna Jablonski said,

"Is Inequality Making Us Sick?" The title of the link at the bottom of the post makes a strong statement. It associates social discrimination and discrepancies in healthcare- a connection that is accurate but also widely unacknowledged. The underlying problem of healthcare inaccessibility in the United States is its selective catering to specific groups of people, specifically those who will be profitable to service. This problem precedes even the need for preventative healthcare, because at this point, the knowledge to live a healthy lifestyle isn’t even accessible to many. The issue of education is comparable to healthcare in that in that it can be boosted by implementations such as affirmative action, or in the case of healthcare, a public option. However, neither will experience widespread improvement unless change happens from the ground up. The term “reform” means effective and significant change. This means acknowledging the known social determinants of health and specifically addressing the needs of high-risk groups. Reducing these gaps is the only way to begin true “reform.”

12:10 a.m. on October 7, 2009Samantha Stern said,

I believe that our society has perceived these changes to our healthcare system as just alterations to the broad category of health insurance. The media reports constantly on the controversies surrounding universal health care, medical expenses, as well as Medicare and Medicaid, but they never seem to touch in depth on the topic of an ENTIRE health reform. This health reform would include topics such as education and inequalities. There needs to be an understanding that our entire health system is failing, not only insurance.
We go to college to learn. This learning allows us experience in understanding topics which assist us in making the wise choices concerning our careers in the future. This same topic can apply to health education. If our society was fully informed on topics such as staying healthy or avoiding diseases, it would prevent issues in the long run. Because these issues would no longer exist money would not be wasted. I believe this to be an important aspect concerning lowering costs that pertain to our health care system. Being educated would also help us understand other aspects that effect of health rather than just how our bodies feel one day to the next. Income, neighborhoods, race, ethnicity, as well as recreation all play a part in our health. People need to understand how these decisions affect their overall health.

2:00 p.m. on October 25, 2009Catherine Kirchhoff said,

Being capable of reading this blog post and having knowledge to respond is already creating separate layers similar to the layers health care puts individuals on. There are those who would read this and have no idea what Stewart is saying and then there are those like those in his classes who are slowly beginning to comprehend what he is stating.
The layers I am discussing are the layers that different individuals are all on. Whether it be layers of different SES’s, those who have knowledge, those who have means, those who have time and those who are insured. There are cardiologists who earn thousands of dollars for performing procedures vs. sitting down and discussing alternative ‘lifestyle’ factors to help prevent coming to their office in the first place.
I agree with Stewart, removing the financial barriers is the only way to improve health status for a large amount of people. We could be reforming health care with knowledge, however time and means get in the way. Means causes a dilemma because too many people do not have means. Means would get them a nicer neighborhood, closer to a decent grocery store, health insurance, possibly a bigger backyard and would hopefully eliminate some added unnecessary stress. This is key in helping individuals and “reforming” health care but we seem to be struggling with what the actual word ‘health’ means. Health is not just being healthy rather one’s entire lifestyle-which needs to be considered and applied to evaluate the health care we receive.

8:43 p.m. on November 1, 2009Meghan Taglang said,

As a country we seem to be looking for a blanket solution that will make the entire helth care system better by only changing one thing. The "health insurance reform," as it kept being refered to in the article is what we are hoping to solve all our problems but this change, if it works at all, will not solve everything. The issue of prevention is something that has been overlooked in all this talk of reform. We cannot hope to make our country any healthier just by changing the way people pay for their doctors. Our country’s overall health has been declining, meaning we are becoming less active and we reach for the unhealthy food choices out of convenience and habit rather than eat the food that help our body keep itself going. The issue of prevention needs to be stressed more than the surgeries and procedures used to fix the problem once it has reached its worst stages. If the doctors were paid the same amount of money to talk with patients about preventative measures as they were to perform surgeries, maybe they would be able to avoid the surgeries altogether.
The focus of the government reform, along with its money, I believe, needs to be shifted to programs that raise awareness of the issues facing Americans today when it comes to their health. Lunch menus in schools need to be geared towards healthy choices and breakfast should be a meal provided as well. Safe neighborhood would increase the amount of physical, outdoor activity a person could do to increase their health. Health prevention classes should be provided and doctors should spend more time talking with their patients about increasing their health to avoid the surgeries.
In conclusion, I completely agree with what Mr. Auyash is saying. We need more than just a change in the way we pay for health care, the health care itself needs to be reformed if we wish to combat the rise in problems today.

4:20 p.m. on November 4, 2009Brittany Dover said,

I agree that most people in the United States are looking for a simple one problem fix. Every time I hear something on the news about health insurance as a reason why so many Americans are unhealthy I always go back to what I've learned in my health and health policy classes. There never seems to ever be one to solution to the many problems we have when it comes to Americans health.
I agree that many Americans are unhealthy not just because they're uninsured or underinsured, but because they don't do anything for their health (prevention) until they're actually sick. I believe my mother is a good example, she has cardiac myopathy, arthritis in multiple joints, back problems, and feet problems. Even though she has these many health related problems, I've never actually seen her make a great lifestyle change. The only change I've seen is when she stopped salting things because her doctor told her to. I've never actually been into the doctors office with her, but from what I can tell no doctor has really given her advice on how to prevent her problems or even help make them better before they got worse. My mother now needs knee replacement surgery (the other one will need to be replaced eventually as well), she was told she eventually would need back surgery, and she has to buy special shoes for her feet. She's never to my knowledge changed her diet or exercise to help her heart or to lose weight so she could help prevent her back and knee problems. Maybe her doctors thought that because she was a nurse that she didn't need to hear "the speech," but in my opinion most doctors don't educate their patients.
I believe prevention would be a great thing for the government to invest in, but most people, the government and the American public together don't want to spend the money. As Americans, we want everything right now and we want to see results right away. I am guilty of this as well, I love eating junk food and I rarely eat anything healthy plus, I don't exercise regularly anymore. I am blessed right now with being healthy and not overweight, but I also know that individual's who look "healthy" can have high cholesterol and other health problems. I just don't see the point right now to eat healthy and exercise when I am already healthy. This also illustrates that just because someone is educated about health, I feel like I'm somewhat health educated, it doesn't mean they will change their behavior. The pessimist in me believes we'll never have education, better living conditions for those who can't afford it, and I believe we'll always live in a country with racial inequalities. There has never been a window of opportunity for those types of preventative measures, to my knowledge, to be put into effect. It's very costly and telling the public that it'll pay off in the long run goes against our human nature. Like I said we want results now.

1:28 a.m. on December 7, 2009Natasha Murphy said,

I have read the original blog posted by Mr. Auyash and responses from each of the bloggers before me. It's amazing how we can all agree and understand each others perception on the "health" reform topic. It is hard to accept that our government and political officials can't seem to do the same.
Many times I believe that the health reform topics along with many of the other controversial issues in the media are prolonged, over debated, and many times still leave the viewers with many unanswered questions. I am in my first semester of grad school working towards a MPH degree. Honestly, I just recently began keeping up with current news and issues in the media for the problems previously mentioned. I decided to keep up with the debates and read articles and such to better understand the pros and cons of the health reform. Instead of becoming more educated and having a clear understanding; I became more confused and frustrated. This is not just a problem in the media, it is a problem encountered when visiting doctors, talking to health insurance agents, reviewing a printed diagnosis from doctors, and reviewing insurance policies. Many times patients are giving a sheet or a brief explanation in technical terms that have no meaning to them. I have been in this situation myself. And of course, instead of asking the doctor to explain in laymen terms, I continued to nod my head and smile as if I understood.
The U.S. has to do a better job! It is still unreal to me that we live in such a powerful nation of which, the inequalities and health disparities that exist make the citizens seem so powerless. But the truth of the matter is that we are not powerless, we have the power to motivate, influence, and eventually change things for the better. It is just a matter of educating ourselves and others, and pushing for policy change in areas that present social injustice or further spread health disparities.